 Hello and let's talk about a COVID-19 situation in Tamil Nadu. Chennai district as well as certain parts of three other districts in the state are set to go into lockdown again on Friday till June 30th in a move that is a whole country watching. The state has the second highest number of cases in the country at just over 50,000. The city of Chennai is emerged as a hotspot with 35,500 cases approximately. On Wednesday, the state recorded 2,174 cases, the highest in a single day so far. Of these, Chennai accounted for 1,276 cases. The state also saw administrative reshuffle last week with health secretary Bila Rajesh replaced by former health secretary Jay Rathakrishna. This new lockdown has raised many questions both about the state's handling of the disease as well as how effective this lockdown is likely to be. To find out more about this, we talk to Dr. C. T. Sundaraman of the Jain Swasti Abhiyan. Here is what he had to say. Thank you so much Dr. Sundaraman for joining us. So to start, to talk a bit about the situation in Tamil Nadu, we know that it is one of the states with pretty good health facilities. In fact, it's actually a center for what is called medical tourism. People from various parts of the world come there for treatment. It also has been known for a fairly efficient bureaucratic system. At least in the past, the state has dealt with disasters. But right now, there seems to be a lot of confusion on the ground and the lockdown is going to be reinforced in four districts. So is this a question of a particular extra level of mismanagement or is it some people are of course saying that Tamil Nadu is actually ahead of the curve in declaring this and other parts might even have. So how do you see the situation right now in Tamil Nadu? Ah, there's a lot of questions within your one question. So it's not one question at all. So let me try to say, I don't think Tamil Nadu is ahead of the curve. I think Bombay and Delhi have declared their additional deaths, the missing deaths. I think looking at Tamil Nadu figures that they would also have something to declare. I would not be surprised if there is a death correction from there. Their current death figures are too low. And part of it is the convergence problem that Bombay and Delhi had. So the death figures will high. But in practice, it would be much higher. But relative to other states, what they are saying is the same trend. So we are not saying too much. But this projection of Tamil Nadu has an unusually low mortality. That I don't think we need to go with that. It's just a bit of high. But it's not unusually high mortality either. The virus does what the virus does and it does not make any particular concession for Tamilians or this. That's particularly the situation. As a health system, Tamil Nadu is a very robust health system. I think we should not lose sight of that, despite some of the gaps that have occurred on this. Tamil Nadu has had some health system, has had some fault lines. Those fault lines tend to get exacerbated by this COVID-19. That has this tendency to take up and catch you on whatever weak point you have and present that. One of the fault lines of Tamil Nadu, other than its high degrees of iniquity, which people do not quite recognize, is very much higher in Tamil Nadu compared to many states. That has a very high iniquity problem. And the problem could be in a level of denial of the existence of iniquity. The other big problem is Tamil Nadu's health system is very bureaucratically driven, very administratively driven. Very, very limited or no role for Pachayats and for community engagement. In the corporations where the problem is worst, there are no corporate electors, there are no corporate councillors, there are no want members. There is nobody who can speak for the community. Now this is very traditional. They pride themselves on administration and they are good administrators. I would say I have experienced it elsewhere also. They are very good in their public health departments, one of the most competent departments. But they don't have community engagement. And here is a situation where it actually needs. It's interesting that just before this pandemic broke, they were thinking of correcting that weakness. They were conscious of it. But I think this got them on the thing. So the first one month, if you look at March, Tamil Nadu performed admirably well. It was on par with Kerala. Somewhere it got diverted and distracted by saying, this tablighi Muslims are the only people having it, 90% of cases are from them. Even then I was scared that we are just not looking elsewhere. And true enough when they started looking into elsewhere, the Koyenbeidu, Flara, Pankard, and there were other chains of transmission. It was impossible, whatever the problems with that group. It was impossible that there is only one chain of transmission that can account for 90% of cases. Clearly they were not looking. And therefore when they started looking, they found the Chennai cluster, which by then had gone out of proportions. Unlike what you had in Bangalore and in the Triangram, where they were able to be on top of the problem all the time. Because they were actually on the lookout for it. So there was this particular chain. And Chennai cooperation doesn't have some of the rural structures that are necessary for community engagement. They do not necessary for primary care. And therefore the Tamil Nadu, the Chennai situations kept running out. Also, Chennai is one of the busy airports, lots of points of entry, the February thing. So these factors put together. Remember, but that period of March, when you saw that Bombay was already peaking, Tamil Nadu was not doing very badly. It was actually, subsequently, they attributed to the market, but it could have been any number of markets. The fish market was also doing the same thing. So it was, but it was somewhere that later that they did that. And then when it came to contact tracing, when it came to this, there was a, shall I say, an undue keenness on forcing the figures to remain low at the cost of a wider testing. Particularly one problem happened, which I think Tamil Nadu really paid very much for, is that in the pursuit of keeping deaths low and numbers low, there was, I think, a substantial number of cases that we were hearing who were denied admission because they were too sick, not all the sick people getting tested for COVID-19, certain keeping up a narrative, which I think they have currently corrected because after this new secretary, you see the death rates are much more realistic. I'm not saying they're high. People will immediately say, now you have 49, 15 deaths, there were 18 deaths before. Those 18 deaths before were a problem. They represented partly people who were not documented, but partly who were turned away at the door. And that means they would be a source of strength. So imagine 2,000 cases coming from Dave. If they are in search of care and they visit one, two, three, four places before they get admission. Each patient will himself infect 100 people. That means not infect, they would come into contact with 100 people. So you would have two lakh contacts for the current number of cases per day. So it's extremely important that when a patient has symptoms, he reaches care without getting into contact with anything else in the surrounding. That I think remains a weak spot. So I think that is part of the reasons why Chennai was this. Also a lot of distractors, a lot of effort going into unproductive types of control, paying places. You have a curfew after 7 p.m. in the night. You locked on geographically a zone and declare a buffer zone. That was Chennai's great solution. They invented it, but thoroughly did not help because they needed contact tracing, which was not a police function. It was a community function. And they did not and have not yet got enough community volunteers on this. So that's I think one set of problems. The other set is the rising. The problem is not already there. The problem is rising. The districts. Now the districts have very limited cases. So here are situations. Never mind, Chennai is a big place. Twice as big as South Korea. So it can take each district separately and make sure the disease is contained there. But the surveillance systems in the districts are weak. So if you have a good surveillance, you'll catch the clusters when you're small. Implement contact tracing and isolation measures, which will limit it. The lockdown is very inefficient because you cannot know which person is the contact. But a very focused contact tracing will help contain those cases and keep the districts small. But I am worried that some districts, as they start testing, are going to show up higher clusters. And then you can have many more Chennai's and that would be very unfortunate because actually they can avoid it. The rural system is much better and they should be able to avoid it. But if they fail to do adequate surveillance testing, which means you must test every person with COVID-like symptoms, whether or not they have a contact history, whether or not can be. This whole business of community transmission has lulled us from testing people who are symptomatic, but without contact history so that new clusters can rise unnoticed and become proving. When they are small, you can contain them. When they are large, you need mitigation, extra beds, you have problems of management. That is the danger. They can get out of it. They are on the cusp of it. I think that hopefully the coming week they will do something to get that better. Right. So you would not, for instance, recommend, you would not see the re-imposition of the lockdown as a very efficient solution because like over the past couple of days there have been similar discussions with regard to Delhi, whether if there is a need for a second lockdown, whether it might actually help stem the cases. So if there is a mouse in the house, you can burn down the house to get to that mouse and or you can search for the mouse. It may be very difficult, very illusive, but eventually when you burn it down, the mouse may still survive. You see the problem about is you lockdown is an extreme measure. It could be there, there could be cases and circumstances when it is merited. I don't want to rule it out. Prime office, you know, lockdown. But I really think that right now they need to focus on this thing. But I can see in Chennai, there is some sort of a thing. But let us say if there is a political compulsion to go ahead, they should at least accompany it but a far, far greater intensified contact tracing community engagement using this process of mitigation for that, plus build up something like 20,000 more beds to be ready for what will happen with the lockdown less. We are likely to run into lacks because we may not get that in control and we need to get ready for that. And I think we have a problem even now in ventilation management, things like that which I think needs to be strengthened. So if they use it for doing a health system preparedness that they should have done in April, well, everybody is learning, I'll be charitable about that. So they can, and they intensify testing. But if they use the lockdown as a substitute for doing this, they are really lost. They are really lost. Then Chennai will be in a real soap, I hope. And I do think that they will not make that mistake. Thank you so much, Dr. Sundar. I want to talk about this. Thank you. In our next segment, we continue with discussions around the COVID-19 pandemic and the medicines that are going to be used to treat patients. Prabhupur Kaisa and Dr. Satyajit Rath discuss this issue. Today we are going to discuss at least some positive results that seem to have come from the recovery trials in Oxford. Now we have with us Satyajit Rath who has been educating us about the various medical and the health aspects of this particular epidemic, COVID-19. Satyajit, for the first time, we have some positive news which says trials have succeeded, at least it's only a press release, but the trials have succeeded in showing a significant drop in deaths using dexamethasone, the esteroid, which is quite easily and cheaply available. Yeah. So this is one of those examples, I think, where it's what Slang would let you call a no-brainer. Okay. In fact, the Oxford University Press release itself points out that dexamethasone, which is simply one of a large variety of corticosteroids that are clinically in wide use for many decades, and all of those uses one way or another, broadly, reduce inflammation. Okay. If you look at the last three months, there have been easily approaching 100 publications that have examined, thought about, tried out various corticosteroids such as dexamethasone in patients of COVID-19, and some have said, yes, they see an effect, some have said, no, they don't really see an effect. Pretty much all of them say, we at least haven't seen any bad effects. So there's no problem with trying it out, exactly how to use it, and whom to use it, still remains of itself. So the real novelty of the news from Oxford, and I hasten to point out that it's news. We have yet to see any data leave alone a peer reviewed publication. So this is not even at the pre-print level. This is at the level of a press release alone. Like the Gilead science result of remdesivir. So, and then as we pointed out at that time, it's not surprising given the anxiety around that these releases are happening, but at least the Oxford release cannot be looked at suspiciously with the perspective of, are they trying to increase their share value and so on and so forth? Because text methison is just a generically available drug. And it's very cheap, even in India, I think you can get it for 20 is very, very cheap in a few years, virtually. Absolutely, so, and if the claim is correct, and I see no reason to think that it's not, then these are reliable statistically robust results that say that a cheap generic easily made easily accessible already very widely available and accessible because it's used in such a great diversity of situations in certain circumstances. Drug can provide an advantage in the most seriously ill COVID-19 patients. So, this is the other part, this is really for those who are seriously ill, which means, as we have discussed earlier, there is a serious lung inflammation and therefore taking care of that and dressing that would at least help in reducing the number of deaths. That's the basic underlying issue with using this kind of corticosteroid for COVID-19 serious cases, right? Yes, there's an interesting little wrinkle into that, which the press release, which is really the only documentation we have available to us, points out quite helpfully, that the improvement seems to be most striking in the most seriously ill patients. Those are better letters. It's a little less striking in those who are not quite as ill, meaning those who are on oxygen, but not on ventilators. And it's not apparent so far at least in those who are only moderately ill. And an interesting issue related to that is the likelihood that both inflammation in the lungs and overflow inflammation all over the body, what physicians would refer to as systemic inflammation, which simply means body-wide inflammation, which you begin to see in seriously in patients of COVID-19. That's the situation in which an anti-inflammatory steroid like dexamethasone seems to help most. That's all we have time for today. We'll be back tomorrow with major news developments from the country. Until then, keep watching Newsweek.